title: Multi-disciplinary management for patients with oligometastases to the brain: results of a 5 year cohort study.
abstract: BACKGROUND
  The incidence of oligometastases to the brain in good performance status patients is increasing due to improvements in systemic therapy and MRI screening, but specific management pathways are often lacking.
  
  
  METHODS
  We established a multi-disciplinary brain metastases clinic with specific referral guidelines and standard follow-up for good prognosis patients with the view that improving the process of care may improve outcomes. We evaluated patient demographic and outcome data for patients first seen between February 2007 and November 2011.
  
  
  RESULTS
  The clinic was feasible to run and referrals were appropriate. 87% of patients referred received a localised therapy during their treatment course. 114 patients were seen and patient numbers increased during the 5 years that the clinic has been running as relationships between clinicians were developed. Median follow-up for those still alive was 23.1 months (6.1-79.1 months). Primary treatments were: surgery alone 52%, surgery plus whole brain radiotherapy (WBRT) 9%, radiosurgery 14%, WBRT alone 23%, supportive care 2%. 43% received subsequent treatment for brain metastases. 25%, 11% and 15% respectively developed local neurological progression only, new brain metastases only or both. Median overall survival following brain metastases diagnosis was 16.0 months (range 1-79.1 months). Breast (32%) and NSCLC (26%) were the most common primary tumours with median survivals of 26 and 16.9 months respectively (HR 0.6, p=0.07). Overall one year survival was 55% and two year survival 31.5%. 85 patients died of whom 37 (44%) had a neurological death.
  
  
  CONCLUSIONS
  Careful patient selection and multi-disciplinary management identifies a subset of patients with oligometastatic brain disease who benefit from aggressive local treatment. A dedicated joint neurosurgical/ neuro-oncology clinic for such patients is feasible and effective. It also offers the opportunity to better define management strategies and further research in this field. Consideration should be given to defining specific management pathways for these patients within general oncology practice.
authors.affiliation: Department of Radiotherapy, University College London Hospital, Euston Road, London NW12BU, UK. jillianmaclean@nhs.net
authors.forename: Jillian
authors.initials: J
authors.lastname: Maclean
authors.forename: Naomi
authors.initials: N
authors.lastname: Fersht
authors.forename: Mausam
authors.initials: M
authors.lastname: Singhera
authors.forename: Paul
authors.initials: P
authors.lastname: Mulholland
authors.forename: Orla
authors.initials: O
authors.lastname: McKee
authors.forename: Neil
authors.initials: N
authors.lastname: Kitchen
authors.forename: Susan C
authors.initials: SC
authors.lastname: Short
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D058016:Health Facility Administration / Q000379:methods*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods* / Q000458:organization & administration*; D008875:Middle Aged; D055815:Young Adult